CMS expands Medicaid postpartum coverage into four new states

Photo: Jose Luis Pelaez Inc/Getty Images

The Centers for Medicare and Medicaid Services has given the approval for California, Florida, Kentucky and Oregon to expand Medicaid and Children's Health Insurance Program coverage to up to one year postpartum – bringing the total number of states increasing postpartum Medicaid coverage to 11.

CMS estimates this would affect about 126,000 families annually across the four states.

Calling it a "significant step forward" for maternal health, Health and Human Services Secretary Xavier Becerra said Wednesday that families "deserve the peace of mind knowing they will be able to access the healthcare coverage they need, without interruption."

The expansion of coverage in California, Kentucky and Oregon was made possible by a new state plan opportunity included in the American Rescue Plan. Florida will offer its coverage through a Medicaid and CHIP section 1115 demonstration.

The four states join South Carolina, Tennessee, Michigan, Louisiana, Virginia, New Jersey and Illinois in extending Medicaid and CHIP coverage from 60 days to 12 months postpartum. 

CMS said it continues working with other state partners to extend coverage for 12 months after pregnancy, which has also been proposed in states, including Indiana, Maine, Minnesota, New Mexico, Pennsylvania, West Virginia, North Carolina, Washington and Connecticut, as well as Washington, D.C. 

As a result of these efforts, as many as 720,000 pregnant and postpartum individuals across the U.S., annually, could be guaranteed Medicaid and CHIP coverage for 12 months after pregnancy, said CMS.

WHAT'S THE IMPACT?

Medicaid covers 42% of all births in the nation, according to federal data. CMS framed the new option for states to extend Medicaid and CHIP coverage as part of the Biden Administration's ongoing efforts to address disparities in maternal health outcomes.

According to a report published by the HHS Office of Assistant Secretary for Planning and Evaluation, one in three pregnancy-related deaths occurs between one week and one year after childbirth.

The current administration has backed a number of policies aimed at improving maternal health. Last year, President Biden issued the first-ever Presidential Proclamation marking Black Maternal Health Week, coupled with a set of initial actions to address the Black maternal health crisis; and Vice President Kamala Harris hosted the first-ever White House Day of Action on maternal health.

In addition, HHS recently issued a new final rule for Title X, the nation's family planning program, to ensure access to affordable family planning services.

It also announced $6.6 million through Title X to address the demand for family planning services where restrictive laws and policies have impacted reproductive health access, or in states where there is a lack of or limited Title X access. In addition, the agency advanced its maternal health priorities, including expanding access to postpartum Medicaid coverage, rural healthcare services and implicit-bias training.

THE LARGER TREND

The Biden Administration initially expanded Medicaid and CHIP postpartum coverage in April, which was facilitated in part by the American Rescue Plan, which included an option for states to offer 12 months of postpartum Medicaid eligibility.

To receive federal funds and ensure consistency with federal standards, including those set by the ARP, states must go through a formal process run by CMS. States choosing to extend postpartum coverage must elect this option in both Medicaid and their separate CHIP programs, if applicable, and submit required state plan amendments to CMS. The new ARP state plan option is limited to a five-year period that ends March 31, 2027.

States like Louisiana that adopt the new extended postpartum coverage must provide coverage to all eligible individuals who were enrolled in Medicaid or CHIP while they were pregnant. This extended coverage period will last from the day the pregnancy ends through the end of the month in which their 12-month postpartum period ends.

The postpartum coverage option extends to current beneficiaries who are enrolled in Medicaid or CHIP while pregnant but are no longer pregnant when the state implements the ARP option – if they're within the 12-month postpartum period when their state implements the option. It also applies to those who were pregnant at some point during the three months prior to applying for Medicaid if they met the eligibility requirements at that time.
 

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com